ALL THE COMSAE TEST QUESTIONS WITH 100% CORRECT ANSWERS.docx, Exams of Biology

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ALL THE COMSAE TEST QUESTIONS WITH 100% CORRECT ANSWERS drug for UC/Crohns - ANSWER sulfasalazine pulmonary effects of CF - ANSWER chronic bronchitis an dbronchiectasis osteoporosis affects what parts of bone? - ANSWER (spongy and ) trabecular bone mass loss imipramine - ANSWER TCA SE: Tri-Cs convulsions coma cardiotox antichol effects- confusion in elderly; (acute glaucoma and orthostatic hypotension- block alpha1) viscerosomatic - ANSWER visceral disease --> somatic finding loratidine vs ranitidine - ANSWER loratidine: 2nd gen H1 blocker, doesnt cross BBB --> less sedating ranitidine: H2 receptor antagonist (like cimetidine) cells w RBCs inside - ANSWER entaemoba histolytica which type of pneumothorax causes tracheal deviation to the contra side? - ANSWER tension intracerebral hemorrhage adjacent to a lesion that contains a tangle of numerous tortuous vessels - ANSWER AVM arteriovenous malformation 2 causes of SCID - ANSWER ADA deficiency (adenosine deaminase required for degradation of adenosim and deoxyadenosine - in ADA deficiency, high levels of dATP --> toxicity in lymphocytes --> SCID hypoplastic thymus lithiums effects on urination - ANSWER inhibits vasopression/ADH --> increased urinary frequency infertility drug that can result in multiple fetuses - ANSWER clomiphene (clones- multiple babies) antagonist at estrogen R in hypothalamus (thus inhibits normal negative feedback) upregulates LH and FSH release from pituitary --> ovulation used to treat PCOS but can cause ovarian enlargement, multiple fetuses AFP levels in down syndrome - ANSWER low GI malformation A/W down syndrome - ANSWER Hirschprungs- congenital aganglionic megacolon defective relaxation and peristalsis of rectum and distal sigmoid colon failure to pass meconium, empty rectal vault, megacolon myasthenia gravis associations - ANSWER thymoma, thymic hyperplasia ptosis, diplopia, can affect chewing, swallowing, speaking, shoulders, respiration tx for tinea - ANSWER azoles beta blockers for asthma - ANSWER none- even beta 1s can be nonselective at higher doses what kind of teratogenic effects are seen w ACE/ARBs - ANSWER fetal renal agenesis stones bones groans moans psych overtones - ANSWER high Ca or PTH PTH is made by what cells? - ANSWER chief cells of parathyroid gland PTH inhibits reabsorption of phosphate where? increases calcium resorption where? - ANSWER PO4- proximal tubule ca- DCT anterior innominate rotation means tight hip flexors or extensors? - ANSWER extensor- hamstrings thoracic CS - ANSWER E SaRa most common cause of cellultis - ANSWER staph aureus, strep pyogenes butterflies huge pair of cocc catching stamp hip restricted in internal rotation dx? - ANSWER innom outflare immune complex in glomerular mesangium 2 days after URI berger or PSGN? - ANSWER berger PSGN is 2 wks post URI kidney ureter viscerosomatic innervation - ANSWER T10-11 college student w nonspecific symptoms nonproductive cough, sore throat CXR- diffuse infiltrates - ANSWER myco PNA test for trichomonas - ANSWER nucleic acid amplification painless enlarging tumor in left testis 75 yo - ANSWER diffuse large B cell lymphoma most common in 70-80s choriocarcinoma affecst what age group - ANSWER 15-35 yolk sac tumor affects what population - ANSWER infants and children 1-2 years Sensourineural hearing loss, tinnitus, paralysis of facial muslces, loss of corneal reflex - ANSWER Cerebellopontine angle tumor - between cerebellum and lateral pons -- CNs 5, 7, 9 Sleep changes in depressed patients - ANSWER decreased slow-wave sleep, decreased REM latency, REM early in sleep cycle, increased total REM sleep, repeated nighttime awakenings, early- morning awakenings Cachexia mediated by - ANSWER TNF-alpha, IFN- gamma, IL-6 Tx for Orotic aciduria - ANSWER Uridine - inhibits carbamoyl phosphate synthetase Short acting benzos - ANSWER ATOM Alprazolam, Triazolam, Oxazepam, Midazolam Medium acting benzos - ANSWER LET Lorazepam, Estraolam, Temazepam Long acting benzos - ANSWER Clordiazepoxide, Clorazepate, Diazepam, Flurazepam Climacteric period - ANSWER Menopause Compartment syndrome d/t occlusion of: - ANSWER Microvasculature (small arteries) Grave's disease ab - ANSWER anti-TSH Hyperresonance - ANSWER pneumothorax, Large Q-waves - ANSWER Old infarcts Cachexia mediated by - ANSWER TNF-alpha, IFN- gamma, IL-6 Tartrate resistant acid phosphatase positive in - ANSWER Hairy Cell Leukemia Low leukocyte ALP - ANSWER CML Cytosolic steroid receptor - ANSWER VET CAP Vitamin D, Estrogen, Testosterone, Cortisol, Aldosterone, Progesterone Nuclear steroid receptor - ANSWER T3/T4 Tetanus tx - ANSWER Tetanus antitoxin and tetanus toxoid series Balantidium coli - ANSWER protozoa found in pigs Sumatriptan - ANSWER 5-HT 1B/1D agonist --> vasoconstsriction, inhibition of trigeminal activation and vasoactive peptide release Tx of S. pneumonia - ANSWER Penicillin Asthma drugs that cause tremors - ANSWER Albuterol, Theophylline Theophylline MOA - ANSWER inhibits phosphodiesterease --> dec cAMP Xenograft - ANSWER from different species syngeneic graft - ANSWER from identical twin Cyclophosphamide - ANSWER alkylates DNA inferior vesical artery - ANSWER goes to fundus of bladder corticobulbar tract of internal capsule - ANSWER composed of UMN of CNs, for muscles of face, head, and neck all CNs except III, IV, VI inhaled anthrax - ANSWER shows up as mediastinal widening on CXR vaginosis and pH - ANSWER pH of greater than 4.5 is likely bacterial insultation installers - ANSWER susceptible to asbestos junctional rhythm - ANSWER pacemaker is the AV node. it usually presents without a P wave or with an inverted P wave. Retrograde P waves refers to the depolarization from the AV node back towards the SA node ova in stool - ANSWER means one of the following: giardiasis amebiasis children, the diarrhea can be severe. Eosinophilia may be present (differently from other protozoan infections. Cilostazol - ANSWER Cilostazol is approved for the treatment of intermittent claudication Quadrigeminal cistern - ANSWER Superior cistern or cistern of the great cerebral vein Duret haemorrhage - ANSWER Duret hemorrhages are small areas of bleeding in the ventral and paramedian parts of the upper brainstem, (midbrain and pons). They are secondary to raised intracranial pressure with formation of a transtentorial pressure cone involving the cerebral peduncles (crus cerebri) and other midbrain structures caused by raised pressure above the tentorium. Kernohan's notch is a groove in the cerebral peduncle that may be caused by this displacement of the brainstem against the incisura of the tentorium. The resulting ipsilateral hemiparesis is a false localising sign,[3] known as the Kernohan- Woltman syndrome.[4] This may succeed or accompany temporal lobe (uncal) herniation and subfalcian herniation secondary to a supratentorial mass 1mo development - ANSWER focus on face, lifts head, moro reflex, turns to sound, turns head to sound 2mo development - ANSWER Coos, fixe and follow, grasps, smiles responsively, lifts head, turns head to sound 4mo development - ANSWER Coos/squeals/laughs, Bears weight, follow 180 degrees, Grasps, Holds head/chest up, holds small toy, no head lag, reaches, rolls front to back, turns to sound 6mo development - ANSWER Babbles, bears weight, laughs, pulls to sit, responds to name, rolls both ways, sits alone, transfers objects 9 mo development - ANSWER Babbles, claps/waves/peek-a-boo, creepts/crawls, cruises, sits up on own, says mama/dada, plays pat-a-cake, Pincer grasp, pulls to stand, stands with support 12mo development - ANSWER Cruises, fills/empties containers, sits up on own, holds up and drinks, imitates words, pincer grasp, stands a lone, turns pages, says 1-2 words, walks alone 15mo development - ANSWER Climbs furniture, Dances, jargon, rides toys, stacks 2 object tower, stands alone, scoops and recovers, throws ball, uses cup, uses spoon, says 4 words, walks well 18mo development - ANSWER says 8 or more words, feeds self, follows simple directions, imitates housework, knows 2 or more body parts, names pictures, rides toys, runs, uses spoon/fork, walks backward, walks up & down stairs 24mo development - ANSWER 2-word sentences, follows 2-step verbal command, gets along well with fam members, acts worried if parent is sad, helps dress self, holds cup in one hand, jumps with both feet, kicks a ball, removes clothes, runs, walks up/down stairs, scribbles, throws overhand periodontal infections Prophyromonas gingivalis - ANSWER gingivitis, periodontal disease Actinobacillus actinomycetemcomitans - ANSWER another periodontal bug enterovirus 17 - ANSWER notable cause of hand, foot and mouth disease Menkes syndrome - ANSWER inborn error where body cannot absorb copper brittle hair, metaphyseal widening Head and neck - ANSWER T1-T4 Heart - ANSWER T1-T5 Resp - ANSWER T1-T7 Esophagus - ANSWER T2-T8 Upper GI - ANSWER T5-T9 What composes the upper GI? - ANSWER Stomach, liver, gallbladder, spleen, part of pancreas and duodenum Middle GI - ANSWER T9-T12 What composes the middle GI? - ANSWER Portions of pancreas and duodenum, jejunum, ileum, ascending colon, prox 2/3 of transverse colon Lower GI - ANSWER T12-L2 What composes the lower GI - ANSWER Distal 1/3 transverse colon, descending colon, sigmoid colon, rectum Kidneys - ANSWER T11-L1 Upper ureters - ANSWER T10-L1 Lower ureters - ANSWER L1-L2 Urinary bladder and urethra - ANSWER T11-L2 Gonads - ANSWER T10-T11 Uterus and cervix - ANSWER T10-L2 Erectile penis or clit - ANSWER T11-L2 Arms - ANSWER T5-T7 Legs - ANSWER T10-T12 Parasympathetics to everything above lower GI tract, and Kidneys and upper ureters - ANSWER Vagus nerve Parasympathetics to the Lower GI tract, Lower ureters, bladder, urethra, gonads, uterus, cervix, and penis/clit - ANSWER S2-S4 External rotation of shoulder - ANSWER Infraspinatus, teres minor Internal rotation of shoulder - ANSWER Subscapularis, pect major, teres major, lat dorsi Carrying angle of arm increases - ANSWER When wrist adducts and ulna abducts Innervation: Flexors of the wrist and hand besides flexor carpi ulnaris (ulnar nerve) - ANSWER Median nerve Innervation: Extensors of wrist and hand - ANSWER Radial nerve Innervation: Primary supinators of forearm - ANSWER Biceps: musculocutaneous n Supinator: Radial n Innervation: Primary pronators of forearm - ANSWER Pronator teres and pronator quadratus: radial n Innervation: Thenar eminence except abductor pollicus brevis (ulnar) - ANSWER Median n Innervation: Hypothenar eminence and interossi - ANSWER Ulnar n Innervation: 1st and 2nd lumbricles - ANSWER Median n 3rd and 4th lumbricles - ANSWER Ulnar n Cubitus varus and valgus of the arm - ANSWER Less than 3 and more than 15 degrees Difference between problem with median nerve (C6-C8, T1) and with Klumpke's palsy (C7, C8, T1) - ANSWER Both have extension of MCP, Flexion of PIP/DIP. Median nerve has thenar wasting and adducted thumb L1 motor and sensation - ANSWER Iliopsoas; anterior thigh below inguinal ligament L2 motor and sensation - ANSWER Iliopsoas, adductors, and quads; Middle anterior thigh L3 motor and sensation - ANSWER Adductors, quads; Anterior thigh just above knee L4 motor and sensation - ANSWER Anterior tibialis; Medial malleolus L5 motor and sensation - ANSWER Extensor hallicus longus, quads; Dorsal aspect of foot and big toe S1 motor and sensation - ANSWER Peroneus longus and brevus, gastrocnemius; Lateral malleolus Rib muscles for tx - ANSWER Rib 1: Ant and mid scalenes 2: Post scalene 3-5: Pect minor Vertical strain movement - ANSWER 2 parallel transverse axes with sphenoid and occiput in same direction Torticolis - ANSWER Sidebent to affected side, rotated to opposite side CV4 technique - ANSWER Compression of 4th ventricle: thenar eminences on each hand on occipital bone and drawing back during craniosacral flexion, until still point is reached Arrangement of facet orientation for cervicals, thoracics, lumbars - ANSWER BUM, BUL, BUM Scoliosis classifications - ANSWER <20 is mild, 20- 45 is moderate, >45 is severe. Mild and moderate tx with OMT or bracing, severe requires surgery. Resp compromise >50 Cardiac compromise >75 Myokymia that progresses downward - ANSWER Due to internally rotated temporal bone of same side Craniosacral motion - ANSWER Occurs at superior transverse axis, or the respiratory axis at level of S2. During CS flexion, sacrum counternutates and AP diameter shortens Nerve impingements - ANSWER C5: Numbness at lateral elbow and diminished biceps reflex C6: Numbness at lateral forearm, thumb, wrist extensors, and diminished brachioradialis C7: Numbness of middle finger, weakness of finger and elbow extensors, diminished triceps reflex Vault hold - ANSWER Index on greater wings of sphenoid Middle on zygomatic process of temporal bone (ant to ear) Ring on mastoid process of temporal bone (post to ear) Little finger on occiput Thumbs over sagittal suture Spencer's technique - ANSWER 1. Extend shoulder 2. Flexion of shoulder with elbow extension 3. Circumduction w/ compression 4. Circumduction w/ extraction 5. Abduct shoulder 6. Internal and external rotation 7. Pump shoulder Unpasteurized goat cheese - ANSWER Brucella Laxative abuse - ANSWER electrolyte imbalance severe dehydration dependency stretched or "lazy" colon balantidium coli - ANSWER protozoa that causes GI infection, ingest cysts thru infected water or food produces hyalonuridase and creates ulcers in mucosal walls Isospora belli - ANSWER diarrhea, steatorrhea, malabsorption, non-bloody diarrhea Thyroid - ANSWER T2 Upper lung and myocardium - ANSWER T3 Lower lung - ANSWER T4 Acidity of stomach - ANSWER Left T5 Liver - ANSWER Right T5-T6 Gallbladder - ANSWER Right T6 Spleen - ANSWER Left T7 Pancreas - ANSWER Right T7 Small intestines - ANSWER T8-T10 Adrenals - ANSWER T11 Kidneys - ANSWER L1 Bladder and abdomen - ANSWER L2 Prostate/ broad ligament - ANSWER S1 Ovaries - ANSWER T10 Middle ear - ANSWER Superior clavicle Tonsils - ANSWER 1st ICS near manubrium Kidneys (adrenals are 2" superior, 1" lateral) - ANSWER 1" superior and 1" lateral to umbilicus Nasal sinuses - ANSWER Inferior clavicle Lung dz - ANSWER Sternum at 4th ICS Bladder - ANSWER Umbilicus Stomach acidity - ANSWER Left 5th ICS (right is peristalsis) Liver - ANSWER Right 5th and 6th ICS Gallbladder - ANSWER Right 6th ICS Spleen - ANSWER Left 7th ICS Pancreas - ANSWER Right 7th ICS Thyroid gland - ANSWER Sternum at 2nd ICS Esophagus - ANSWER Sternum at 2nd ICS Myocardium - ANSWER Sternum at 2nd ICS Bronchi - ANSWER Sternum at 2nd ICS Pharynx - ANSWER Rib 1 Eye - ANSWER Lateral humerus Struma ovarri - contains functional thyroid tissue. can present as hyperthyroidism. tissue IN the teratoma can have cancer. Brenner Tumor - ANSWER ovarian non germ cell tumor. Benign and unilateral. looks like bladder. solid tumor that is pale yellow-tan in color and appears encapsulated. "coffee bean: nuclei on H&E staining. is made of surface epithelium. contains "urothelium" Krukenberg tumor - ANSWER ovarian non germ cell tumor. is a primary GI malignancy that metastasizes to the ovaries, causing a mucin secreting signet cell adenocarcinoma. a signet cell is a cell where the nucleas is pushed off to the side. Serous Cystadenoma - ANSWER ovarian non germ cell tumor. is cystic and from surface epithelium. is from water and is benign. frequently bilateral, lined with fallopian tube - like epithelium. which have an increase in CA-125 which is the general ovarian cancer marker. good for monitoring progression, not for screening. single cyst with flat lining usually 30-40 years old, surface epithelium. present late, poor prognosis and extend to involve peritoneam. Serious Cystadenocarcinoma - ANSWER ovarian non germ cell tumors. is cystic and is from surface epithelium. malignant and frequently bilateral. psammoma bodies are seen on histology. risk factors include BRCA - 1 BRCA - 2 and HNPCC. significant genetic predisposition makes family history the most important risk factor. malignant clear invasion of cells in CT. larger tumor with complicated cysts with thick shaggy lining. usually post menopausal women 60-70 years of age. Mucinous Cystadenoma - ANSWER ovarian non germ cell tumor. mucous, from surface epithelium. multiocular cyst lined by mucous secreting epithelium. benign, intestine like tissue. Mucinous Cystadenocarcinoma - ANSWER malignant. pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor Fibromas - ANSWER non ovarian germ cell tumors. sex cord stromal. Fibromas,. bundles of spindle shaped fibroblasts. meigs' syndrome - triad of ovarian fibroma, ascites and hydrothorax. with a pulling sensation of the groin. Granulosa theca cell tumor. - ANSWER ovarian non germ cell tumor. sex chord stromal. develops in many ages. secretes estrogen - precosious puberty in young kids. can cause endometrial hyperplasia or carcinoma in adults. call exner bodies - small follicles filled with eosinophilic secretions. abnormal uterine bleeding in adults. leuprolide - ANSWER GnRH analog with agonist properties when used in a pulsatile fashion; antagonist properties when used in continuous fashion (down regulates GnRH receptor in pituitary which leads to a decrease in FSH/LH. used for infertility (pulsatile), prostate cancer (continuous - with flutamade), uterine fibroids (continuous), precocious puberty (continuous). toxicity - antiandrogen, nausea, vomiting. Terbutaline - ANSWER a beta 2 agonist that relaxes the uterus reduces premature uterine contractions. mifepristone (RU - 486) - ANSWER competitive inhibitor of progestins at progesterone receptors. used clinically to terminate pregnancy. is administered with misoprostol (PGE1) toxicity includes heavy bleeding, GI effects (nausa, vomiting, anorexia), and abdominal pain. Anastrozole, Letrozole, Exemestane - ANSWER Aromatase inhibitors used in postmenopausal women with breast cancer. Hormone Replacement Therapy - ANSWER used for relief or prevention of menopausal symptoms (e.g. hot flashes, vaginal atrophy) and osteoporosis (increased estrogen, decreased osteoclast activity) unopposed estrogen replacement therapy (ERT) increases the risk of endometrial cancer so progesterone is added. Possible increase in CV risk. Tamoxifen - ANSWER SERM antagonist on breast tissue used to treat and prevent recurrence of ER- Positive breast cancer. Raloxifene - ANSWER SERM - Agonist on bone; reduces resorption of bonel used to treat osteoporosis. Clomiphene - ANSWER SERM - Partial agonist at estrogen receptors in hypothalamus. prevents normal feedback inhibition and increased release of LH and FSH from pituitary, which stimulates ovulation. Used to treat infertility and polycystic ovarian syndrome. may cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies and visual disturbances. Danazol - ANSWER a synthetic androgen that acts as partial agonist at androgen receptors used clinically in endometriosis and heretitary angioedema. toxicities include weight gain, edema, acne, hirsuitism, masculinization, decreased HDL levels, hepatotoxicity. Sildenafil, Vardenafil - ANSWER inhibits PDE-5 causing an increase in cGMP, smooth muscle relaxation in the corpus cavernosum, increase in blood flow and penile erection. Used in the treatment of erectile dysfunction. toxicity includes headache, flushing, dyspepsia, impaired blue - green color vision. Risk of life threatening hypotension in patients taking nitrates. Estrogens (Ethinyl Estradiol, DES, mestranol) - ANSWER Binds estrogen receptors. Used clinically in hypogonadism or ovarian failure, menstrual abnormalities, HRT in postmenopausal women; use in men with androgen-dependent prostate cancer. toxicity increases the risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of the vagina in females exposed to DES in utero, increase risk of thrombi. contraindications - ER - positive breast cancer, history of DVT's Glucocorticoids - ANSWER Hydroxycortison, prednisone, triamcinolone, dexamethasone, beclomethasone. - decreases the production of leukotrines and prostaglandins by inhibiting phospholipase A2and expression of COX - 2. Used clinically in addisons disease, inflammation, immune suppression, asthma. toxicity includes iatrogenic cushings syndrome - buffalo hump, Sulfanylureas: 1st gen - tolbutamide and chlorpropramide. 2nd generation - Glyberide, Glimepiride, Glipizide - ANSWER these drugs close K+ channel in beta cell membrane, so the cell depolarizes which leads to triggering of insulin release via a calcium influx. used clinically to stimulate the release of endogenous insuling in type 2 DM. Require some islet function function, so useless in type 1 DM. first generations cause disulfiram like effects. second generation can cause hypoglycemia. Insulin - ANSWER binds insulin receptor (tyrosine Kinase Activity) in the liver it increases glucose stores as glycogen. in muscle it increases glycogen and protein synthesis. K+ uptake. In fat it aids in TG storage. used in the treatment of Type 2 DM, gestational diabetes, life threatening hyperkalemia and stress induced hyper glycemia. toxicities - hypoglycemia and very rarely hypersensitivity reactions rapid acting insulin - ANSWER Lispro, Aspart, Glulisine the rapid acting insulins don't LAG short acting insulin - ANSWER Regular Intermediate acting insulin - ANSWER NPH Long acting insulin - ANSWER Glargine and Detemir. Propylthiouracil, Methimazole - ANSWER used in hyperthyroidism. blocks peroxidase, thereby inhibiting organification of iodise and coupling of thyroid hormone synthesis. PTU also blocks - 5 deiodinase, which decreased peripheral conversion of T4 to T3. Toxicity includes: skin rach, agranulocytosis (rare), aplastic anemia, hepatotoxicity (PTU). Methimazole is a possible teratogen. Levothyroxine, Triiodothyronine - ANSWER used in hypothyroidism, myxedema. A thyroxine replacement. toxicity includes tachycardia, heat intolerance, tremors and arrhythmias. Growth Hormone - ANSWER used in GH deficiency and turner syndrome. Somatostatin (octreotide) - ANSWER used for acromegaly, carcinoid, gastrinoma, glucagonoma, esophageal varices. Oxytocin - ANSWER used to stimulate labor, uterine contractions, milk let downl controls uterine hemorrhage. ADH (desmopressin) - ANSWER pituitary (central, not nephrogenic) DI Demeclocycline - ANSWER ADH antagonist (member of the tetracycline family) Used in SIADH. toxicity in nephrogenic DI, photosensitivity, abnormalities of bone and teeth risk factors for SCC of the esophagus - ANSWER Alcohol (in US) Alcoholic cirrhosis - ANSWER final and irreversible form. micronodular, irregularly shrunken liver with "hobnail" appearance. Sclerosis around central vein (Zone III). has manifestations of chronic liver disease (e.g. jaundice, hypoalbuminemia. Reyes Syndrome - ANSWER rare, often fatal childhood hepatoencephalopathy. findings include mitochondrial abnormalities, fatty liver (microvascular fatty change), hypoglycemia, vomiting, hepatomegaly, coma. Associated with viral infection (especially VZV and influenza B) that has been treated with aspirin. MechanismL aspiring metabolites decrease Beta oxidation by reversible inhibition of mitochondrial enzyme. Avoid Aspirin in children, except in those with Kawasaki's disease. Budd - chiary syndrome - ANSWER occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain and eventual liver failure). May develop varices and have visible abdominal and back veins. Absence of JVD. associates with hypercoagulable state, polycythemia vera, pregnancy, and hepatocellular carcinoma. ADP receptor inhibitors Ticlopidine prasugrel, ticagrelor clopidogrel - ANSWER inhibit platelet aggregation by irreversibly blocking ADP receptors. Inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen. Used clinically for acute coronary syndrome; coronary stending. decreases incidence or reccurence of thrombotic stroke. toxicity includes: for ticlopidine neutropenia, fever and mouth ulcers. the stomach absorbs? - ANSWER water and alcohol duodenum does - ANSWER digests lipids and absorbs iron (Fe2+ form) Jejunum absorbs? - ANSWER main site of lipid and folate absorption Zinc Deficiency - ANSWER manifests as poor wound healing, dermatitis, skin ulcers, alopecia, decreased taste and smell, depression and diarrhea. hypogonadism, decreased adult hair (axillary, facial, pubic), dysgeusia, anosmia. may predispose to alcoholic cirrhosis Leser Trelat sign - ANSWER a sudden eruption of numerous suborrheic keratoses which are greasy stuck on papules that commonly occur in elderly patients. this is an indicator of gastrointestinal cancer as wells as lung, breast and genitourinary cancers. it is a sign of internal malignancy. Chvostek's Sign - ANSWER on of the signs of tetany seen in hypocalcemia. it is elicited when the facial nerve is trapped at the angle of the mandible. over the masseter muscle. if the sign is positive, the facial muscle will contract momntarily (twitch) Hoffman's sign - ANSWER a tingline sensation triggered by a mechanical stimulus in the distal part of an injured nerve. This sensation radiates diastolic murmur at left sternal border - ANSWER aortic regurgitation pulmonic regurgitation systolic murmer at left sternal border - ANSWER hypertrophic cardiomyopathy systolic ejection murmur at pulmonic area - ANSWER pulmonic stenosis flow murmur (e.g. asd, pda) Pansystolic murmur at tricuspic area - ANSWER tricuspid regurgitation VSD diastolic murmur at tricuspid area - ANSWER tricuspid stenosis ASD Mitral Area systolic murmur - ANSWER mitral regurgitation mitral area diastolic murmur - ANSWER mitral stenosis having the patient inspire does what? - ANSWER increases the intensity of right heart sounds having the patient expire does what? - ANSWER increase the intensity of left heart sounds. Hand Grip Maneuver - ANSWER increases systemic vascular resistance increases the intensity of MR, AR, VSD, MVP murmurs decreases the intensity of AS, hypertrophic cardiomyopathy murmurs. Valsava Maneuver - ANSWER decreases venous return decreases the intensity of most murmurs increases the intensity of MVP, hypertrophic cardiomyopathy murmurs Rapid Squatting Maneuver - ANSWER increases venous return, increases preload, increases afterload with prolonged squatting. Mitral Regurgitation - ANSWER Holosystolic, high pitched "blowing murmur" that is loudest at the apex and radiates toward the axilla. enhances by maneuvers that increase TPR like squatting and hand grip or LA return like expiration. MR is often due to ischemic heart dsease, MVP or LV dilation. Rheumatic fever and infective endocarditis can cause either MR or TR Tricuspid regurgitation - ANSWER holosystolic, high pitched "blowing murmur" that is loudest at the tricuspid area and radiates to right sternal border. Enhanced by maneuvers that increase RA return (e.g. inspiration). TR can be caused by RV dilation. Rheumatic fever and infective endocarditis can cause either MR or TR Aortic Stenosis - ANSWER Crescendo - Decrescendo systolic ejection murmur follwing ejection click. The ejection clic is due to abrupt halting of valve leaflets). LV>> aortic pressure during systole. radiates to carotids/heart base. "pulsus parvus et normal pressure in the left ventricle? - ANSWER 130/0 mmHg normal pressure in ascending aorta/ aortic arch? - ANSWER 130/90 mmHg normal pressure in pulmonary artery/pulmonary trunk? - ANSWER 25/10 mmHg pulmonary artery is where PCWP is measures and is usually <12 mmHg. PCWP in mmHg is a good approximation of left atrial pressure. In mitral stenosis, PCWP is greater than LV diastolic pressure. PCWP is measures with a pulmonary artery catheter (Swan - Ganz catheter). Hyaline Casts - ANSWER solidified Tamm - Horsfall mucoprotein that is secreted from the tubular epithelial cells of individual nephrons. They are increased in the urine when there is low urine flow, concentrated urine, or an acidic renal environment. Therefore, they are commonly increased in individuals with normal renal function who are severely dehydrated or after vigorous excercise. Fatty Casts - ANSWER most commonly associated with nephrotic syndrome. Patients with nephrotic syndrome have hyperlipidemia and lipiduria because increased liver production of albumin leads indirectly to an increase in LDL and VLDL synthesis. Fatty casts form as the resultant lipid - rich epithelial cells are broken down in the glomeruli. HLA-A3 - ANSWER associated with hemochromatosis HLA-B8 - ANSWER associated with Grave's Disease HLA-B27 - ANSWER associated with psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease and reiters syndrome. HLA-DR3 - ANSWER associated with DM type 1 maneuvers that increase pre load - ANSWER mueller maneuver squatting maneuver that increases afterload - ANSWER handgrip maneuvers that decrease preload - ANSWER valsalva and standing Metoclopramide - ANSWER an antiemetic and prokinetic drug for the GI tract. It stimulates peristalsis by antagonizing D2 (dopamine) receptors, thereby increasing resting tone, contractility LES tone, and overall motility. Used to treat Diabetic gastroporesis SE - extrapyramidal symptoms like parkinsonism and dystonia. Meclizine - ANSWER an antihistamine used for nausea and motion sickness. it has anticholinergic properties and can thus produe drowsiness and dry mouth endocrine abnormalities (precocious puberty) and cafe au lait spots. treatment for tinea versicolor - ANSWER selenium sulfatide, topical miconazole Papillary thyroid carcinoma - ANSWER malignant - good prognosis, lymphatic spread, most common thyroid cancer, papillary growth with optically clear nuclie (orphan annie nuclie) (ground glass chromatin) Clomiphine - ANSWER a SERM that inhibits negative feedback of estrogen in the hypothalamus on gonadotropin release causing an increased release of LH and FSH from the anterior pituitary glans which stimulates ovulation. It is used to treat infertility in the setting of PCOS. Osteitis fibrosa cystica - ANSWER bone pain, subperiosteal bone resorption on the radial aspect of middle phalanges along with brown tumors of the long bones. Carcinoid Syndrome - ANSWER flushing wheezing, diahrrea and right sided valvular lesions especially tricuspid regurgitation. needs to have metastasized to the liver because if not and its in the GI tract it is subject to first pass effect so you will not see symptoms. causes of epiddymitis >35 yo - ANSWER ecoli, pseudomonas, proteus causes of epididymitis < 35 yo - ANSWER chlamydia, gonnohrea. Fanconi's syndrome - ANSWER proximal tubular reabsorption defect polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets. GP120 - ANSWER HIV docking protein in viral envelope, formed from cleavage of GP160. responsible for attachment to host CD4+ T cell. ENV GP41 - ANSWER HIV transmembrane protein in viral envelope, formed from cleavage of gp160. responsible for fusion and entry. ENV p24 - ANSWER gag - HIV capsid protein pol codes for? - ANSWER reverse transcriptase, aspartate protease, integrase. B1 - ANSWER thiamine: TPP B2 - ANSWER riboflavin: FAD, FMN B3 - ANSWER Niacin: NAD+ B5 - ANSWER pantothenic acid: CoA B6 - ANSWER pyridoxine: PLP B7 - ANSWER biotin cycle) 3) transketolase 4) branched chain amino acid dehydrogenase. Vitamin B1 (thiamine) defieincy - ANSWER impaired glucose breakdown leading to ATP depletion worsened by glucose infusionl highly aerobic tissues (brain and heart) are affected first. wenicke-korsakoff syndrome and beriberi. Seen in malnutrition as well as alcoholism (2ndary to malnutrition and malabsorption) Wernicke Korsakoff - ANSWER confusion, opthalmoplegia, ataxia (classic triad)+ confabulation, personality change, memory loss (permanent) damage to medial dorsal nucleus of thalamus, mamillary bodies. Dry Beribery - ANSWER polyneuritis, symmetrical muscle wasting Wet beriberi - ANSWER high output cardiac failure (dilated cardiomyopathy) edema. Vitamin B2 (riboflavin) function - ANSWER cofactor in oxydation and reduction (e.g. FADH2) FAD and FMN are derived from riboflavin (B2 = 2ATP) Vitamin B2 (riboflavin) deficiency - ANSWER cheilosis (inflammation of lips, scaling and fissures at the corners of the mouth), corneal vascularization. Vitamin B3 (niacin) function - ANSWER constituent of NAD+, NADP+ (used in redox reactions) derived from tryptophan. synthesis requires B6. NAD is derived from Niacin (B3 = 3ATP) Vitamin B3 (niacin) deficiency - ANSWER glossitis. severe deficiency leads to pellagra which can be caused by hartnup disease (deficiency in tryptophan absorption), malignant carcinoid syndrome (increased tryptophan metabolism) and INH (decreased vitamin B6). symptoms of pellagro are diarrhea, dementia, dermititis and death. Vitamin B3 (niacin) excess - ANSWER facial flushing (due to pharmacologic doses for treatment of hyperlipidemia) Vitamin B5 (pantothenate) function - ANSWER essential component of CoA (a cofactor for acyl B5 is "pento" thenate. transfers) and fatty acid synthase. Vitamin B5 (pantothenate) deficiency - ANSWER dermatitis, enteritis, alopecia, adrenal insufficiency. Vitamin B6 (pyridoxine) function - ANSWER converted to pyridoxal phosphate, a cofactor used in transamination (e.g. ALT and AST), decarboxylation reactions, glycogen phosphorylase. synthesis of cystathionine, heme, niacin, histamine, and neurotransmitters including serotonin, epinephrine, norepinephrine and GABA. Vitamin B6 (pyridoxine) Deficiency - ANSWER convulsions, hyperirritability, peripheral neuropathy (deficiency inducible by INH and oral contraceptives), sideroblastic anemias due to impaired hemoglobin synthesis and iron excess. Vitamin B7 (biotin) function - ANSWER cofactor for carboxylation enzymes which add a 1-carbon man. SAM transfers methyl units. regeneration of methionine (and thus SAM) is dependent on Vitamin B12 and folate. It is required for the conversion of NE to Epinephrine Marasmus - ANSWER energy malnutrition resulting in tissue and muscle wasting, loss of subcutaneous fat, and variable edema. marasmus results in Muscle Wasting Kwashiokor - ANSWER protein malnutrition resulting in skin lesions, edema, liver malfunction (fatty change due to decreased apolipoprotein synthesis) clinical picture is a small child with swollen belly. malnutrition, edema, anemia, fatty liver. Vitamin K Functions - ANSWER catalyzes gamma carboxylation of glutamic acid residues on various proteins concerned with blood clotting. synthesized by intestinal flora. it is necessary for the synthesis of clotting factors 2/7/9/10 and proteins C and S. warferin is a vitamin K antagonist Vitamin K deficiency - ANSWER neonatal hemorrhage with increase PT and increase aPTT but normal bleeding time. (neonates have sterile intestines and are unable to synthesize vitamin K) can also occur after prolonged use of broad spectrum antibiotics. Is not present in breast milk; neonates are given vit. K injection at birth to prevent hemorrhage. Reasons why its decreased in newboards are 1. hepatic immaturity, 2. not in breast milk. 3. sterile GI tract. 4. poor placental transfer of Vit. K. Zinc Function - ANSWER essential for the activity of 100+ enzymes. Important in the formation of Zinc Fingers (transcription factor motif Ethanol Metabolism - ANSWER thanol is converted to acetaldehyse via the enzyme alcohol dehydrogenase and the cofactor NAD+ (to NADH). that happens in the cytosol. In the mitochondria Acetaldehyde is converted to acetate via Acetaldehyde dehydrogenase again with the help of NAD+. NAD+ is therefore the limiting reagent. Alcohol dehydrogenase operates via zero order kinetics. Fomepizole - ANSWER inhibits alcohol dehydrogenase and is an antidote for methanol or ethylene glycol poisening. Disulfiram (antabuse) - ANSWER inhibits acetaldehyde dehydrogenase (acetaldehyde accumulates contributing to hangover symptoms) Vitamin E functions - ANSWER antioxidant that protects erythrocytes and membranes from free radical damage. Vitamin E deficiency. - ANSWER increased fragility of erythrocytes (hemolytic anemia) muscle weakness, posterior column and sponocerebellar tract demyelination) Vitamin C (ascorbic acid) function - ANSWER is an antioxidant. also facilitates iron absorption by keeping iron in Fe2+ reduced state. It is also necessary for hydroxilation of proline and lysine in colagen synthesis. Is also necesary for dopamine beta hydroxylase which converts dopamine. found in fruits in vegetables. C = Colon (descending and ascending) K = Kidneys E = Esophagus (lower 2/3) R = Rectum (lower 2/3) Falciform Ligament - ANSWER connects the liver to the anterior abdominal wall. Contains the ligamentum teres hepatis. (derivative of fetal umbilical vein). Derivative of ventral mesentery. Hepatoduodenal ligament - ANSWER connects liver to duodenum and houses the portal triad. hepatic artery, portal vein and common bile duct. Pringle maneuver, ligament may be compressed bw thumb and index finger placed in omental foramen to control bleeding. Connects greater and lesser sacs. Gastro hepatic ligament - ANSWER connects liver to lesser curvature of the stomach. houses gastric arteries. seperates greater and lesser sacs on the right. may be cut during surgery to access lesser sac Gastrocolic ligament - ANSWER connects greater curvature and transverse colon. houses gastroepiploic arteries. is part of greater omentum. gastrosplenic ligament - ANSWER connects greater curvature and spleen. contains short gastrics and left gasroepiploics. Seperates greater an lesser sac on the left. splenorenal ligament - ANSWER connects spleen to posterior abdominal wall. contains splenic artery and vein and tail of pancreas. phenylalanine and tryptophan are potent stimulators of? - ANSWER also increased by stomach distention and alkanilization, amino acids, vagal stimulation and decreased by stomach pH<1.5. severely increased in ZE syndrome. and increased by chronic PPI use. primary disease prevention - ANSWER prevention of disease occurrence secondary disease prevention - ANSWER refers to early detection of disease tertiary disease prevention - ANSWER aims to reduce the morbidity of an already acquired disease physiological characteristics of cardiogenic shock - ANSWER increased central venous pressure increased pulmonary capillary wedge pressure increased stroke volume decreased cardiac output decreased venous oxygen saturation Rubeola Virus - ANSWER causes measles 3C's cough coryza (cold like symptoms) conjunctivitis koplic spots 0 red oral lesions with white centers found in the buccal mucosa are characteristic of measles in the early stage. all of these symptoms are prodromic and will disappear before the measles rash begins. rash begins 2-5 days later and the child will have a high fever with a a Clostridium difficile - ANSWER metronidazole (alt: vancomycin) -must be PO Corynebacterium diphtheriae - ANSWER erythromycin + antitoxin Gardnerella vaginalis - ANSWER metronidazole (alt: tinidazole) Hemophilus ducreyi - ANSWER azithromycin or ceftriaxone Hemophilus influenzae - ANSWER -cefotaxime or ceftriaxone if life threatening -amoxicillin-clavulanate if non-life threatening Mycoplasma pneumoniae - ANSWER doxycycline or azithromycin Neisseria gonorrheae - ANSWER -ceftriaxone is drug of choice -always treated with doxycycline or azithromycin for chlamydia even if it has been ruled out Neisseria meningitidis - ANSWER ceftriaxone Bacillus anthracis - ANSWER ciprofloxacin + clindamycin + meropenem + raxibacumab Listeria monocytogenes - ANSWER ampcillin + gentamicin Pasteurella multocida - ANSWER amoxicillin or cefuroxime Salmonella typhi - ANSWER ciprofloxacin Shigella species - ANSWER azithromycin or any fluoroquinolone (alt: ceftriaxone) Treponema pallidum - ANSWER penicillin G Trichomonas vaginalis - ANSWER metronidazole (alt: tinidazole) Staphylococcus aureus - ANSWER -oxacillin or nafcillin -dicloxacillin if on skin -if MRSA: vancomycin Streptococcus pyogenes - ANSWER penicillin G or V Genital warts - ANSWER podophyllin resin or cryotherapy or trichloroacetic acid Group B strep prophylaxis for pregnant females - ANSWER penicillin G during labor Staphylococcus saprophyticus - ANSWER any cephalosporin or amoxicillin-clavulanic acid Streptococcus pneumoniae - ANSWER penicillin G Vibrio cholerae - ANSWER IV Ringer's lactate + 1 dose of doxycycline or azithromycin